Evidence of meeting #54 for Health in the 42nd Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was criteria.

A recording is available from Parliament.

On the agenda

MPs speaking

Also speaking

Terry Bolton  Founding Member, Canada's Still Forgotten Thalidomide Survivors
Douglas Levesque  As an Individual
Ivor Ralph Edwards  Professor in Medicine, As an Individual

12:10 p.m.

Professor in Medicine, As an Individual

Dr. Ivor Ralph Edwards

On symptoms, I'm always bothered by that question. As a human being, I want to give the benefit of the doubt to my patients. As a scientist, though, I have to say that if you don't know, for instance, whether or not someone has taken a particular drug, I don't see how you should ever say, “Well, this is caused by the drug.” It is opening a loophole in logic and science that you would never be able to justify, I don't think, not scientifically, anyway. That, I think, is the problem.

In countries like Taiwan and Japan that run a so-called drug relief system, if someone has an adverse effect from drug and it's reported, they decide whether that person should be given any special aid. I rather like that scheme. It's a no-fault compensation scheme...well, it isn't a compensation scheme: it just makes sure that the kinds of disasters that our two witnesses talk about in their lives are remedied as far as is possible.

12:15 p.m.

Liberal

The Chair Liberal Bill Casey

Your time is up.

Mr. Davies, do you have a final question?

12:15 p.m.

NDP

Don Davies NDP Vancouver Kingsway, BC

Thank you.

Dr. Edwards, to make sure I understand, is there a genetic test that can exclude thalidomide embryopathy?

12:15 p.m.

Professor in Medicine, As an Individual

Dr. Ivor Ralph Edwards

No. [Technical difficulty—Editor] as I've said before, the competing probabilities in any causality statement that you make. What you can do is to do a genetic test so that you know that this gene causes this kind of problem, and then look at the family history and see whether this has occurred before in the family. Then you're on as a solid ground as you can be to say that the genetic thing was the cause, not the drug.

12:15 p.m.

NDP

Don Davies NDP Vancouver Kingsway, BC

Can it be said, Doctor, that there is a consensus of diagnostic criteria for thalidomide embryopathy?

12:15 p.m.

Professor in Medicine, As an Individual

Dr. Ivor Ralph Edwards

We have that. It's in the meeting document and, as I say, a little amplified by our work, which is.... Yes, we have that, but the thing is that it's there to be as sure as possible. We can give the probabilities of other things being included, but you would never be sure that they were due to thalidomide.

12:15 p.m.

NDP

Don Davies NDP Vancouver Kingsway, BC

Well, fortunately or unfortunately, we're not scientists at this table. We're policy-makers, and I think the task before us is to try to provide good public policy to determine which Canadians are entitled to compensation. It seems to me that.... Just in this meeting, I've written down a number of symptoms that are associated with thalidomide embryopathy: extra digits, webbing, cysts or ganglia, shortened limbs, inflammation, bowel or bladder issues, gastrointestinal issues, certain cardiac issues, hearing loss, small jaw....

If we're trying to figure out if it's likely that someone was a victim of thalidomide, would it not make sense that if they were born in a place in Canada at a time when thalidomide was being dispensed, if they're in a region where it was being dispensed, if they present to a doctor with not just a hole in the heart—your example is well taken—but a cluster of symptoms, and if they have a number of the symptoms in this cluster, we can be reasonably sure that cluster was likely caused by thalidomide and then qualify them for compensation? If you add in the genetic testing, wouldn't that be a reasonable approach, perhaps not with scientific certainty, but as a policy-maker?

12:15 p.m.

Professor in Medicine, As an Individual

Dr. Ivor Ralph Edwards

I have every human sympathy with it. I listened to the two witnesses, and I have a lot of sympathy, but you will open the floodgates. You will have lots and lots.... One of the things, for example, that has been found in the experimental work is that thalidomide causes an increase in clubfoot in animals—now, that's in animals.

If you were to say that every person with a clubfoot should be compensated, you will cost the health care—

12:20 p.m.

NDP

Don Davies NDP Vancouver Kingsway, BC

But I'm not, Doctor. I'm talking about having a preponderance of.... I listed off a dozen things, and these witnesses have a number of them. If a person has extra digits, and webbing, and a small jaw, and hearing problems, and cardiac problems, and they were born at the time when thalidomide was.... That's the kind of thinking I'm having.

12:20 p.m.

Professor in Medicine, As an Individual

Dr. Ivor Ralph Edwards

We could work out the probabilities of that and therefore have a rational basis for compensation. I'm not saying it would be easy. The rarity of all of this makes scientific work very difficult.

12:20 p.m.

NDP

Don Davies NDP Vancouver Kingsway, BC

Thank you, Doctor.

12:20 p.m.

Liberal

The Chair Liberal Bill Casey

Your time is up.

That concludes our 54th meeting and our questions and testimony from our witnesses.

I want to thank all of you for taking the time to do this. It's been very enlightening for all of us. I'm not sure where we'll go from here, but as a committee we will analyze all the information, and we'll write a report and make some recommendations, if that's the conclusion of the committee.

I especially want to thank Professor Edwards for taking the time to do this from Sweden.

We want to thank the technicians who have so successfully communicated with us and have made the communications available, which have been very good.

With that, I will conclude our meeting on thalidomide. We'll go into committee business for a minute, but we'll take a second and let the witnesses pack up. I believe Mr. Webber has an issue he wants to raise, and we'll do that.

Again, thanks very much. The meeting is suspended.

12:20 p.m.

Liberal

The Chair Liberal Bill Casey

We will come back to order.

I want to make sure everybody knows that we're going to do drafting instructions for this thalidomide study. If anybody has recommendations on changes or recommendations that we want in the report, we should have them prepared for May 18. That's a week from today. We're also going to do clause-by-clause on Bill C-211 that day. We're going to have witnesses for Bill C-211 on Tuesday.

That's it, but again, if you have some thoughts on this issue, we'd sure like to have them.

Mr. Webber, I understand you have a motion.

May 11th, 2017 / 12:20 p.m.

Conservative

Len Webber Conservative Calgary Confederation, AB

I do, Mr. Chair.

I would like to present the following motion, which was submitted in advance, of course, as per the committee requirements. The motion reads as follows:

That the final framework on Lyme disease not be tabled until the Standing Committee on Health has had the opportunity to review the draft work which should aim to (a) establish proper guidelines regarding the prevention, identification, treatment and management of Lyme disease and the sharing of best practices throughout Canada, and (b) ensure the creation and distribution of standardized educational materials related to Lyme disease for use by any public health care provider within Canada designed to increase national awareness about the disease and enhance its prevention, identification, treatment and management.

I table this motion because a year ago, almost to the day, there was a clear sense of hope in the Lyme disease community. A federally funded Lyme disease conference was held right here in Ottawa in May of 2016. There was a sense that finally experts in the field of Lyme disease would be engaged in the drafting of the federal framework outlined in Bill C-442, MP Elizabeth May's bill.

The Federal Framework on Lyme Disease Act was passed on June 11, 2016. The MPs and senators who passed this bill into law passed it with the understanding that it was to be consultative. But that sense of hope has faded. This federal framework on Lyme disease is being written behind closed doors. It is to be released later this month.

A draft framework was released in February of this year, and the reaction to it was fierce. Dr. Melanie Wills, director of the Canadian Lyme Science Alliance and a professor of molecular and cellular biology at the University of Guelph, said the following:

As a researcher in the field of Lyme disease biology, I am dismayed by the lack of scientific rigor, collaboration, and leadership demonstrated in this document. The Framework does not provide a balanced or holistic portrayal of the biomedical literature, nor does it capture the experiences and needs of Canadians who are suffering from Lyme disease. The CLSA strongly advocates a thorough, inclusive, critical, and transparent evaluation of all available meritorious scientific evidence, as well as meaningful integration of input from diverse stakeholders. We can, and must, do better.

Dr. Liz Zubek, a family physician who specializes in the treatment of Lyme disease, said the following:

This draft Framework tells me to follow outdated guidelines that haven’t been revised in over 10 years. There has been an explosion of research in the past decade and newer guidelines exist that include patient input. This draft Framework also suggests that, as a doctor, I should be satisfied with our inadequate Canadian tests for now, and that maybe in the future we will find improvements. This is, frankly, ridiculous.

I urge the Minister of Health to reject the Draft Framework and insist on a real Canadian action plan for Lyme disease. This needs to be created in partnership with people affected by Lyme and those researchers and doctors who are actively attempting to treat them.

Finally, these are the words of Rossana Magnotta, a director of the Canadian Lyme Disease Foundation:

We call on the Minister of Health to intervene and insist on patient experts being involved in the writing of the framework, even if that means delaying the report to parliament. This is the correct and ethical thing to do.

Mr. Chair and colleagues, 38,000 Canadians have signed a petition clearly denouncing Canada's draft action plan on Lyme disease. The draft proposal ignores science and many major concerns that were raised at the conference. Major concerns include poor diagnosis, treatment plans that fail, human-to-human transmission, and blood bank contamination—yes, blood bank contamination.

You can see that there are some serious concerns by both professionals and patients within the Lyme disease community that this framework may lack some key items. I would like to give the Lyme disease community reassurance that they are included in the drafting of this framework. I am aware, colleagues, that this committee has no more days or time available in the near future to undertake any more studies. I'm aware of that, and I'm also aware that Health Canada intends to release this framework on Lyme disease at the end of the month.

Therefore, this motion I put forward proposes that, through the clerk, of course, we receive a copy of the framework in advance of the final copy being generated so that we can add our constructive input. I'm suggesting that we can review it independently, on our own time, as our meeting schedule is already full.

In the end, it will be we MPs who will have to answer to this framework, and it sure would help if any questions we have could be resolved ahead of the drafting of the framework. I think our input would be most valuable if it is contributed before the document is finalized, because once this framework is written, it's basically written in stone. It would be difficult to change.

Ideally, I would imagine that we could have a draft framework document for about a week to provide our input before it goes to final print, and if this proves to be a successful approach, it may help this committee in future issues.

I conclude with this question: do we all agree that having our input would be a valuable contribution to the process of developing an action plan framework on Lyme disease?

Thank you, Mr. Chair.

12:30 p.m.

Liberal

The Chair Liberal Bill Casey

Thank you very much. I think a lot of us have questions about Lyme disease.

I've looked at your motion, as I discussed with you earlier. The House of Commons instructed the minister to develop a framework, and we can't overrule that. It's out of our scope. It's out of our mandate. We can't do that. The motion you've submitted is out of our scope. It's out of order, because we just can't overrule the House of Commons. To do that, we'd have to go back to the House of Commons and move a motion there, but we can't overrule the instructions of the House to the minister to produce the framework.

Just as an aside, my understanding is that it has been changed. It has been amended and several things have been added to it. I don't know what they are.

Anyway, I'm ruling the motion as presented out of order.

12:30 p.m.

Conservative

Len Webber Conservative Calgary Confederation, AB

Mr. Chair, I'd like to respond to that.

12:30 p.m.

Liberal

The Chair Liberal Bill Casey

Sure.

12:30 p.m.

Conservative

Len Webber Conservative Calgary Confederation, AB

First of all, I think it would be helpful to the Department of Health to have our input and to have the input of our constituents who are suffering from Lyme disease. I assume all of you have met with the Lyme disease community. They have been on Parliament Hill numerous times to meet with MPs to talk about the serious issues that were not included in the draft framework.

You say to me, Mr. Chair, that perhaps the items that were not included in the draft framework are now in the final framework. I would like to see that before it is released, so that there are assurances in the community that this is a quality document.

12:30 p.m.

Liberal

The Chair Liberal Bill Casey

Dr. Carrie.

12:35 p.m.

Conservative

Colin Carrie Conservative Oshawa, ON

Thank you, Mr. Chair.

I would like to take just a moment here. I worked with Ms. May when we brought this forward. Again, there was a certain intent to come up with a framework that would be making a difference. The reality for all of us around the table is that we have not seen the final draft. You've heard.... I do appreciate your input in saying that it has been changed, but I have been meeting with Lyme disease advocates and patients who have Lyme disease, and there is a significant concern.

I think my colleague's intent here.... Maybe there are procedural things that we could do if we were to get unanimous consent or agreement in certain areas to make things move forward because, just as we saw with this study we're doing on thalidomide, sometimes you have a certain intent and if you get it in advance, maybe there's a way you could have improved outcomes....

I was wondering if my colleague would consider a friendly amendment. I would say that at the front of his motion, we would put “That the Standing Committee on Health request that...”. We would see if that is something that you would be able to take a look at without ruling it out of order. I realize that the House of Commons—

12:35 p.m.

Liberal

The Chair Liberal Bill Casey

I've ruled that it's out of order. The clerk advises me that it ends that issue.

12:35 p.m.

Conservative

Colin Carrie Conservative Oshawa, ON

Oh, it does, does it?

12:35 p.m.

Liberal

The Chair Liberal Bill Casey

I think many of us are interested.

To me, it's a very confusing subject, and there are so many different points of view and perspectives, but this motion I have to rule out of order because it overrules the House of Commons.

Mr. Oliver.

12:35 p.m.

Liberal

John Oliver Liberal Oakville, ON

I share the concerns of my colleagues across the table. In my community, there's a very active group of people who are suffering from Lyme disease and some of the chronic conditions of Lyme disease, and they were in to see me after they had reviewed the draft report, indicating their concern with the draft report. It seemed to come down to this: was all the scientific evidence reviewed and were different weightings given to it?

I've heard very clearly from the Lyme disease community. I haven't heard from the Department of Health. I'm wondering whether the motion might be that we ask the department—I'm not sure who we're asking, but it would be whoever is involved with drafting the report—to come to the committee to talk about the work they've done and the preparation of the material. I don't think we can do a full study on Lyme disease and tear apart a report that Health Canada has put together, but I think we could hear from them and ask questions about the process of developing the report and how they've dealt with the concerns that have come from it.

It's difficult to see the affected community so disenfranchised with the report coming from Health Canada. There's a gap here somehow. Maybe we could help with that ongoing relationship if we heard from Health Canada about how they prepared it, what evidence they looked at, and how they were dealing with the concerns coming from the Lyme disease community, the people suffering with this.

12:35 p.m.

Liberal

The Chair Liberal Bill Casey

I'm going to hear from Mr. Davies and then Dr. Carrie. If it's okay, I'm then going to ask Mr. Oliver if he'd present a motion. If we all agree to it, we don't need advance notice.